INCONTINENCE

"Ask Doctor P."

My bladder gives me no warning and sometimes I don’t make it to the bathroom. What does this mean?

Like 50 million other Americans you may have an overactive bladder or (OAB). Symptoms include:

Sudden urges to urinate sometimes with leakage (urge urinary incontinence).

Excessive daytime urination

Waking up at night to urinate

How do you treat OAB?

Treatment starts with conservative measures including:

Eliminating caffeine, acid and alcohol from your diet.

Treating constipation.

Managing underlying medical conditions like diabetes and sleep apnea with your primary care provider.

When these measures fail to improve your symptoms, a trial of an OAB medication is reasonable. Unfortunately, these medications can be expensive or cause bothersome side effects. But rest assured, there are safe minimally-invasive treatments available including:

  • Bladder chemodenervation (Botox®)
  • Percutaneous Tibial Nerve Stimulation
  • Sacral Neuromodulation with Axonics®

Which one is best?

I will guide you through the various treatment options so YOU CAN CHOOSE the therapy that is best for your body.

Whenever I try to exercise or have to cough/laugh/sneeze, some urine comes out. Is this normal?

No it is not normal! You don’t ever have to live with urinary leakage. This condition is called stress urinary incontinence: the involuntary loss of urine with physical activity.

Why does this happen? The muscles and tissues supporting the urethra are damaged or weakened by:

  • Childbirth
  • Gynecologic Surgery
  • Smoking
  • Obesity
  • Genetics

What treatments are available for stress incontinence?

The only non-invasive therapy for the treatment of stress urinary incontinence is pelvic physical therapy. Also known as Kegel exercises, these are most effective when performed with the guidance of an experienced pelvic physical therapist.

Vaginal inserts are used by some women. However they require frequent changing and don’t allow for intimacy.

The gold standard for the treatment of stress incontinence is a minimally invasive mid-urethral sling. During an outpatient 30 minute surgery, the sling is placed under the urethra through a single-vaginal incision. With only a 2 week recovery period, patients are back to activities and work rather quickly. Patient satisfaction rates from slings are historically > 85%.

Wait a minute, are those slings made of mesh? I heard mesh is “bad.”

Mesh has received a very bad reputation in the media due to devices and inserts that are no longer on the market. Like any medical device or insert, there are inherent risks to placing anything in our bodies that is not “natural.” In terms of female mesh, almost all mesh complications were due to large pieces of vaginal mesh used to treat pelvic prolapse (vaginal prolapse). These are distinctly different surgeries for a different set of problems then we are discussing here.

Mid-urethal slings have a reported erosion rate of 4/1000. The most current sling, Solyx™ is only 3.5 inches long and <1 mm in thickness.

I’d really prefer to not have anything “foreign” in my body. Are there other options?

Absolutely. A non-mesh pubovaginal sling using your own body’s tissue can be performed. This surgery involves harvesting a graft from a piece of fascia (lining of muscles) through a bikini-line incision. Due to the incision, this surgery requires a longer recovery period (4-6 weeks) and can have complications such as a hernia or wound infection. Nonetheless, the results are excellent and similar to the mid-urethral mesh slings.